Resident Survey Reveals Much Satisfaction But Important Problems
As Chief of Emergency Medicine at St. Michael’s Hospital, Professor Glen Bandiera has a frontline view of the stresses and strains at play in a busy teaching hospital. For medical residents – MD grads who are training for another 2-7 years in their chosen specialty – the stakes are high and the environment can be more than stressful.
“We are actively working with our hospital partners to ensure respect and dignity is central for all trainees, physicians and staff, as well as the patients we care for,” says Bandiera, Associate Dean, Postgraduate Medical Education at U of T’s Faculty of Medicine. “Everyone at the table sees the learning environment as a key priority.”
Bandiera and his colleagues are taking action armed with the largest and most in-depth survey of the learner experience to date: more than half of the almost 2,000 Toronto-wide medical residents responded to a confidential U of T survey last year, answering questions about their overall satisfaction with residency and career path, and their treatment by supervisors, colleagues and patients.
The survey found 70 per cent of residents had an “excellent” or “very good” residency experience in the last year. It also showed that 80 per cent of residents experienced training opportunities tailored specifically to their needs in the past academic year, challenging perceptions that large organizations cannot provide personalized opportunities.
However, the survey also found that in 2016, 28 per cent of residents experienced harassment in the past year. As well, 29 per cent said they’d been discriminated against based, for example, on their race, gender, sexual orientation, citizenship, or other identity as defined by the Ontario Human Rights Code.
“This is unacceptable to all of us as teachers, as mentors and leaders, and as members of care teams. These data will help us make the learning environment the best it can be – a commitment shared by all of our hospital partners,” says Professor Salvatore Spadafora, Vice Dean of Post-MD Education, who oversees the university’s many medical residency programs.
Spadafora and other leaders from the Faculty of Medicine have met with the CEOs of Toronto’s teaching hospitals, who pledged their full cooperation in making the learning environment a priority over the next two years. The initiative is being co-chaired by Professor Allan Kaplan, Vice Dean of Graduate and Life Sciences Education and Golda Milo-Manson, Vice President of Medicine and Academic Affairs at Holland Bloorview Kids Rehabilitation Hospital. So far, plans include town halls on Islamophobia and other types of discrimination, and efforts to increase mentorship and “allyship” – in which all allied health professionals are trained in how to respond when a patient, for example, refuses to be seen by a non-white physician.
“Across our network of learning sites, in partnership with the hospitals, I’d like to see an approach where all people in the system could feel empowered to speak up,” says Spadafora. “I don’t believe right now we’ve got the right tool kit for people to feel empowered to intervene. That requires training.”
Many Toronto hospitals already have efforts in place that improve the learning environment. Spadafora and Bandiera praised the Sinai Health System’s program to promote allyship – teaching staff how to interrupt discrimination and harassment when they see colleagues being targeted. The Are You an ALLY Campaign includes educational resources such as videos and an e-learning module for all hospital staff.
Melanie Bechard, president of Resident Doctors of Canada, agreed that the survey results around discrimination and harassment were not surprising but were an important step forward. “We recognize that in all aspects of life, there’s discrimination,” says the third-year U of T pediatrics resident. “Some of it is overt, but more commonly I think we see a lot of covert discrimination, and medicine is no exception. I think it’s beneficial to be aware. I speak on behalf of all residents when I say that we really appreciate our experience is being valued and assessed.”
To that end, faculty leaders are planning similar surveys for medical faculty and MD students.
“I think we need to get more data,” says Spadafora. “We’re seeing one important piece of the puzzle. I’m very much concerned about the learning environment of our residents, but I’m also concerned about everyone else in that same environment.”
Bechard would like to see expanded hours and access to resident wellness services at U of T. “I know we have a wonderful, committed office on resident wellness, but some colleagues say they have a really hard time accessing its resources. One colleague said ‘I’m stressed about work and I’d like to do something about it, but I’d have to take off work to do it.’ More weekend and evening hours would be tremendous.”
She also pointed out that only 65 per cent of graduating residents were satisfied with their chosen career path, according to the survey. Sitting down with residents to learn more about that would also be helpful, she says.
For Bandiera, the survey has generated three priorities: the need for faculty leaders to be very clear about expectations around appropriate behaviour; creating a culture that encourages reporting of problems and ensures the safety of those who come forward; and the ability to respond, not just to individuals, but to patterns over time.
Those patterns should be easier to recognize because the survey is longitudinal: more than 80 per cent of respondents have agreed to be followed over the years, allowing faculty leaders to assess the success of different interventions. “This creates a golden opportunity for us in coming up with solutions,” says Bandiera. “The Faculty and hospitals are committed to addressing this.”
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